Coverage Details Archive
Preventive Care Coverage
Preventive care coverage is coverage for medical services that focus on preventing disease and evaluating a person’s current state of health. Examples include annual well visits, most immunizations, and screening tests such as mammograms.
When it comes to out-of-pocket expenses for certain preventive services, there is a distinction between “no-cost-share preventive care” under the ACA and other services that may be considered preventive by you or your health care provider.
We provide members with a list of no cost-share preventive services. It is important to know the difference between preventive services and diagnostic services. Learn more about preventive vs. diagnostic services.
- Legislative Update: Texas Judge Ruling on ACA Preventive Care Services
- Full printable list of 2023 coverage no-cost preventive care medications (PDF)
- Full printable list of 2022 coverage no-cost preventive care medications (PDF)
- More on Preventive Care (PDF)
- Learn about CGHC population health management
Understanding Prior Authorization
Prior Authorization is the practice of getting certain medical services approved by your insurance provider before receiving treatment. There are certain medical services that require Prior Authorization before they will be eligible for coverage under your benefits. These can include tests, procedures, medical equipment and medications.
All in-network providers know Prior Authorization must be obtained before they provide these services to you. Before receiving treatment, we recommend you check with your provider and Common Ground Healthcare Cooperative if a prior authorization is needed. It is your responsibility to be certain prior authorization was obtained in order for the service to be applied to your benefits.